Fillable FINANCIAL ARRANGEMENT FORM (New Mexico Educational Assistance Foundation)

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FINANCIAL ARRANGEMENT FORM (New Mexico Educational Assistance Foundation)

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FINANCIAL ARRANGEMENT FORM
Name of Borrower
Account Number(s)
Dear Borrower:
This letter is in reference to your student loan account(s).
We acknowledge your financial situation and your willingness to make alternate payment arrangements.
Since you are unable to remit the amount required to bring your account(s) current, you must apply to the
lending institution for these arrangements. If you have received this type of benefit previously and your
financial situation has not improved, you must apply for a renewal of your agreement.
This form is provided for your convenience and must be sent to University Accounting Service, LLC., P.O. Box
932, Brookfield, WI 53008-0932.
Complete Parts I, II, and III. Be as thorough as possible. Provide ALL information and include supporting
documentation as requested. THE TYPE OF BENEFIT GRANTED DEPENDS ON THE INFORMATION
YOU PROVIDE AND WHEN YOUR LOANS WERE MADE. Your school will notify you of its decision
regarding alternate payment arrangements, and your school will determine the length of such arrangements.
UAS will bill you according to the agreement established by your school. Statements sent during the
agreement may reflect a "temporary amount due" on the bottom portion. The upper portion will reflect the
amount due according to your original repayment schedule, including any past due amounts. This will help
you monitor the status of your account(s).
For Federal loans, lending institutions are required to impose
late charges
on all past due amounts
regardless of alternate payment arrangements. If these charges are appropriate to your situation, they will
be included on future notices. If payments are not received in this office by the fifteenth (15th) of each
month, you will receive past due notices that reflect all past due amounts based on your
original
repayment
schedule. When making payment, please include the bottom portion of the statement and write your account
number on your check.
YOUR LOAN (S) WILL CONTINUE TO BE REPORTED TO NATIONAL CREDIT
BUREAU (S) IN THEIR APPROPRIATE STATUS.
Remember, if granted, all arrangements are temporary. They may be considered invalid if you do not follow
the requirements made by the lending institution. Billing would resume at the regularly scheduled amount,
including any applicable past due.
Sincerely,
Contract Servicing Department
New Mexico Educational Assistance Foundation
FAF-105 January 2000
SSN:
PART I - MUST BE COMPLETED BY BORROWER
FINANCIAL STATEMENT
1. Marital Status:
(check one)
2. Dependents
Name Relationship Age
Single Widow(er)
Married Divorced or Separated
3. Monthly Income:
Gross Monthly Income $
Deductions $( )
Net Monthly Income $
Spouse's Net Monthly Income $
Public Assistance (list type ) $
Support Income (if separated or divorced) $
Other Income (list type ) $
TOTAL MONTHLY INCOME $
Monthly Expenses:
Balance Outstanding Monthly Payments
Mortgage/Rent $
$
Car Expenses
Loan $
$
Gas, Oil, Insurance $ $
Bank Loans (list type):
$ $
$ $
$ $
Excluding your Perkins Loan, list by name and provide supporting documentation for all other
Educational loans
.
Include total loan amounts, loan balances and monthly payment amounts.
Original loan amount:
$ $
Original loan amount: $ $
Original loan amount: $ $
Other Outstanding Loans (personal) $
$
Credit Cards:
$ $
$ $
$ $
Medical $ $
Utilities $
Telephone $
Insurance (Life, Health, Home) $
Food $
Monthly Support Payments (if separated or divorced) $
Other Expenses:
$
$
TOTAL MONTHLY EXPENSES $
NET Total
(Monthly Income Minus Total Monthly Expense) $
Assets:
Savings Account Balance (Bank Name)
$
Checking Account Balance (Bank Name) $
PART II - MUST BE COMPLETED BY BORROWER
4. Employment Information:
Provide information for current or most recent employer.
Employer Name:
Employer Address:
City State Zip
Employer Phone: ( )____________________________
Area Code
Number of Hours Worked per Week:
Hourly Rate: Date last worked:
Check all that apply:
I am employed and experiencing financial difficulty
(See financial statement on previous page)
I am seeking and unable to secure full-time employment.
I have registered with an employment agency.
(Provide registration documentation)
I am receiving unemployment benefits.
(Provide official documentation of this benefit)
I am not eligible to receive unemployment benefits.
(Provide supporting documentation of ineligibility)
I have never been employed.
5. Other situations. Check all that apply: (Supporting documentation may include: check stubs, employer stubs, benefit
verification on official letterhead, copy of Federal Tax Return)
I have been granted economic hardship for a Federal Direct Student Loan or a Federal Family Education Loan. (Indicate
dates of hardship period:
)
Attach official documentation of this benefit.
I am receiving payment under federal or state public assistance. (AFDC, SSI, Food Stamps, State-sponsored General
Assistance, etc.)
Attach supporting documentation.
6. Describe below the circumstances of your present financial situation.
7. If you feel you can make payments toward your account(s), complete this section.
Based on my financial situation, I can make monthly payments in the amount of $
. If this agreement is
approved, I will make payment of this amount each month as a condition of this agreement. If payment is not made, I
understand that this agreement may be terminated by the lending institution.
If payment is not received between the first and the fifteenth of each month, you will receive past due notices which reflect all
past due amounts based on your original repayment schedule.
8.
I am able to pay the interest due
throughout
any hardship or forbearance benefit granted, please bill me.
I am unable to pay the interest due throughout any hardships or forbearance benefit granted. I will pay the interest
due
after
my hardship deferment or forbearance has ended. I understand interest that has accrued will be billed in a
lump sum at the end of the hardship deferment or forbearance and is due and payable upon receipt.
PART III - MUST BE COMPLETED BY BORROWER
Borrower is responsible to advise UAS of current address!
***Your 14 digit account number ensures proper handling of this form***
NAME OF BORROWER
ACCOUNT NUMBER(S)
PERMANENT STREET ADDRESS
CITY, STATE, ZIP
SOCIAL SECURITY NUMBER
HOME PHONE NUMBER
Check if new address
AREA CODE ( )
WORK PHONE NUMBER
AREA CODE ( )
NAME OF LENDING INSTITUTION DATE LEFT
(College/Univ. from which loan originated) LENDING INSTITUTION
I understand that all information and supporting documents given will be held in strictest confidence and will not be subject to dissemination outside the requirements of the Lending Institution. I further
understand that this arrangement will consist of reduced or deferred payments, as determined by the Lending Institution based on my financial situation. It may be necessary to make accelerated
payments at the expiration of this arrangement to repay the loan within the maximum ten-year period.
I certify that all statements made are true and correct. I also certify that I will immediately notify the Lending Institution of any change in my employment status or significant change in my financial
situation. I authorize a representative of the Lending Institution to obtain pertinent information from applicable parties for verification purposes.
Borrower Signature Date
All arrangements must be approved by the Lending Institution only. Please forward completed form to:
(The Lending Institution will notify you if your form has been approved)
PART IV - TO BE COMPLETED BY LENDING INSTITUTION
- Lending Institution should detach and send this page to UAS
for processing. Lending Institution official must send borrower verification of benefits granted or benefit denial.
Economic Hardship Deferment
(Code G)
(36 month max. benefit) (Fund 97 eligible 7/1/95 and forward)
(Funds 01-95 eligible 10/7/98 and forward)
Dates:
to
Unemployment Deferment
(Code U)
(36 month max. benefit) (Fund 97 eligible 7/1/95 and forward)
(Funds 01-95 eligible 10/7/98 and forward)
Dates:
to
Hardship Deferment
(Unlimited) (Funds 01-95 only)
Dates:
to Type J or K
(J: Int. billed at end of deferment)
Form Disapproved
(K: Int. billed throughout deferment)
A letter was sent to borrower by lending institution to
approve/deny
requested benefits. (Circle one)
Signature of Lending
Forbearance
(All funds) (effective 7/1/95 - 36 month max. benefit)
Dates:
to Type: H or B
(H: Int. billed throughout)
Satisfactory Arrangement to Repay Loan
(B: Int. billed at end of
(AKA / Monthly Payment Agreement) deferment)
Auto
Full-term
Dates:
to
Account Number(s)
Amount $
Amount $
Amount $
Monthly Total $
Institution Official Title Date
PART V - TO BE COMPLETED BY UAS
Economic Hardship: # of months Code
to
Grace Period Ends:
Unemployment Deferment: # of months Code
to
Grace Period Ends:
Hardship Deferment: # of months Code
to
Forbearance: # of months Code
to
Satisfactory Arrangements to Repay the Loan
(See criteria in Section IV for billing information)
Form Processed By
Date:
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FINANCIAL ARRANGEMENT FORM (New Mexico Educational Assistance Foundation)

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Completed 11 June 2021

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